• Samantha Levine, Katie Heiden-Rootes, and Joanne Salas.
• From St. Louis University School of Medicine, St. Louis, MO (SL); Medical Family Therapy Program, Department of Family and Community Medicine, St. Louis University, St. Louis, MO (KHR); Research Division, Department of Family and Community Medicine, St. Louis University, St. Louis, MO (JS).
• J Am Board Fam Med. 2022 Dec 23; 35 (6): 109211021092-1102.

IntroductionTransgender and nonbinary (TGNB) adults face significant barriers to healthcare, including healthcare denials, limited access to clinicians, and mistreatment by healthcare clinicians. While prior studies have explored the consequences of overt discrimination in healthcare, they often overlook the possible impacts of more subtle forms of discrimination.AimIs there a relationship between specific healthcare experiences, including both overt and subtle forms of discrimination, and mental health/substance use among TGNB adults?MethodsThis study was a secondary analysis of the 2015 U.S. Transgender Survey (USTS), a cross-sectional survey conducted by the National Center for Transgender Equality (NCTE) that included 27,715 TGNB adults from across the US and several US territories. This study analyzed variables including healthcare experiences, mental health, and substance use outcomes.ResultsDoctors refusing to give non-TGNB-related care was associated with 71% increased odds of severe psychological distress and 95% increased odds of suicidal ideation. Further, having to teach doctors about TGNB care and doctors asking invasive questions were associated with all our studied negative mental health outcomes. Doctors asking invasive questions was additionally related to increased odds of heavy alcohol use, marijuana use, and illicit drug use.ConclusionsThe results of this study indicate that negative health care experiences are significantly associated with mental health and substance use for TGNB adults. Specifically, these results emphasize the role of more subtle forms of discrimination, including a lack of clinician knowledge about the care of TGNB patients, asking invasive questions, and treating TGNB patients with respect.© Copyright by the American Board of Family Medicine.

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